Provider Demographics
NPI:1013972439
Name:PIKEVILLE FOOT CARE CENTER PLLC
Entity Type:Organization
Organization Name:PIKEVILLE FOOT CARE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADWELL
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHANEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:606-432-0003
Mailing Address - Street 1:126 TRIVETTE DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501
Mailing Address - Country:US
Mailing Address - Phone:606-432-0003
Mailing Address - Fax:606-432-0076
Practice Address - Street 1:126 TRIVETTE DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501
Practice Address - Country:US
Practice Address - Phone:606-432-0003
Practice Address - Fax:606-432-0076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY80900269Medicaid
KY80900269Medicaid
KY5404890001Medicare NSC